Organization
WILLIAM E LEADINGHAM, OD, PSC
Active
Other names
Neuro Visual Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM E LEADINGHAM OD (OWNER)
(606) 329-8672
Entity
Organization
Contact information
Practice address
1330 CARTER AVE, ASHLAND, KY 41101-7544
(606) 329-8672
(606) 329-1258
Mailing address
PO BOX 2005, ASHLAND, KY 41105-2005
(606) 329-8672
(606) 329-1258
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1659-DT
KY
152W00000X
Optometrist
748-DT
KY
152WV0400X
Vision Therapy Optometrist
Primary
748-DT
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000305761
ANTHEM BLUE CROSS
KY
01
—
3810007345
WEST VIRGINIA MEDICAID
WV
05
—
77903664
—
KY
Enumeration date
08/31/2006
Last updated
11/01/2011
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